Family-based prevention of youth alcohol use

Review question

We reviewed the evidence about the effects of family- or parent-based programmes as a way of preventing or reducing alcohol use in school-aged children.

Background

Alcohol use puts young people at increased risk for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents.

Search date

The evidence was current to June 2018.

Study characteristics

We found 46 randomised controlled trials (studies where participants were randomly allocated to one of two or more intervention or control groups) that compared family-based interventions versus no intervention or an adolescent component alone. We included studies targeting general populations of parents and children (universal interventions), those targeting parents of children at increased risk of alcohol use (selective interventions), and studies targeting parents of children already using alcohol (indicated interventions). We were interested in studies following participants up to four years post intervention.

Most studies were conducted in the United States or in European countries (the Netherlands, Sweden, Poland, and Germany). One study was conducted in India. Interventions were delivered in various settings including the child's school or family home and via the Internet or print material. Interventions varied in intensity, duration, and approach, but all targeted alcohol or other drug use by promoting positive parenting approaches or enhancing parent-child relationships. The interventions focused on communication, family dynamics, rule-setting, and risk management.

The total number of participants in the included studies was 39,822, and the young people targeted ranged from 5 to 17 years of age. Participant ethnicity was mixed, with 12 studies targeting ethnic minority groups specifically.

Key results

Overall, we found no evidence for the effectiveness of family-based interventions on the prevalence, frequency, or volume of alcohol use among young people. Some analyses focusing on specific subgroups of studies (e.g. including only universal interventions, targeting ethnic minority groups) showed small intervention effects, but considering variation in results, variation between studies, and overall low quality of the evidence, we are uncertain whether these interventions have a positive effect on young people's alcohol consumption. Some studies reported positive intervention effects on secondary outcomes (parental supply of alcohol, family involvement, alcohol misuse, and alcohol dependence) but with small numbers; these studies could not be pooled, so the evidence is insufficient. No adverse effects were reported.

Quality of evidence

Overall, only very low- or low-quality evidence shows the small effects found in this review. Many of the studies did not adequately describe how families/young people/parents were allocated to the study groups, or how they concealed the group allocation from participants and personnel. We downgraded the quality of evidence due to the heterogeneity (variability) between studies and imprecision (variation) in results. These problems with study quality could result in inflated estimates of intervention effects, so we cannot rule out the possibility that slight effects observed in this review may be overstated.

The US National Institutes of Health (NIH) and the National Institutes of Alcohol Abuse and Alcoholism (NIAAA), Drug Abuse (NIDA), and Mental Health provided funding for over half (28/46) of the studies included in this review. Three studies provided no information about funding, and only 13 papers had a clear conflict of interest statement.

Authors' conclusions: 

The results of this review indicate that there are no clear benefits of family-based programmes for alcohol use among young people. Patterns differ slightly across outcomes, but overall, the variation, heterogeneity, and number of analyses performed preclude any conclusions about intervention effects. Additional independent studies are required to strengthen the evidence and clarify the marginal effects observed.

Read the full abstract...
Background: 

Alcohol use in young people is a risk factor for a range of short- and long-term harms and is a cause of concern for health services, policy-makers, youth workers, teachers, and parents.

Objectives: 

To assess the effectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age).

Specifically, on these outcomes, the review aimed:

• to assess the effectiveness of universal family-based prevention programmes for all children up to 18 years (‘universal interventions’);

• to assess the effectiveness of selective family-based prevention programmes for children up to 18 years at elevated risk of alcohol use or problem drinking (‘selective interventions’); and

• to assess the effectiveness of indicated family-based prevention programmes for children up to 18 years who are currently consuming alcohol, or who have initiated use or regular use (‘indicated interventions’).

Search strategy: 

We identified relevant evidence from the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, MEDLINE (Ovid 1966 to June 2018), Embase (1988 to June 2018), Education Resource Information Center (ERIC; EBSCOhost; 1966 to June 2018), PsycINFO (Ovid 1806 to June 2018), and Google Scholar. We also searched clinical trial registers and handsearched references of topic-related systematic reviews and the included studies.

Selection criteria: 

We included randomised controlled trials (RCTs) and cluster RCTs (C-RCTs) involving the parents of school-aged children who were part of the general population with no known risk factors (universal interventions), were at elevated risk of alcohol use or problem drinking (selective interventions), or were already consuming alcohol (indicated interventions). Psychosocial or educational interventions involving parents with or without involvement of children were compared with no intervention, or with alternate (e.g. child only) interventions, allowing experimental isolation of parent components.

Data collection and analysis: 

We used standard methodological procedures expected by Cochrane.

Main results: 

We included 46 studies (39,822 participants), with 27 classified as universal, 12 as selective, and seven as indicated. We performed meta-analyses according to outcome, including studies reporting on the prevalence, frequency, or volume of alcohol use. The overall quality of evidence was low or very low, and there was high, unexplained heterogeneity.

Upon comparing any family intervention to no intervention/standard care, we found no intervention effect on the prevalence (standardised mean difference (SMD) 0.00, 95% confidence interval (CI) -0.08 to 0.08; studies = 12; participants = 7490; I² = 57%; low-quality evidence) or frequency (SMD -0.31, 95% CI -0.83 to 0.21; studies = 8; participants = 1835; I² = 96%; very low-quality evidence) of alcohol use in comparison with no intervention/standard care. The effect of any parent/family interventions on alcohol consumption volume compared with no intervention/standard care was very small (SMD -0.14, 95% CI -0.27 to 0.00; studies = 5; participants = 1825; I² = 42%; low-quality evidence).

When comparing parent/family and adolescent interventions versus interventions with young people alone, we found no difference in alcohol use prevalence (SMD -0.39, 95% CI -0.91 to 0.14; studies = 4; participants = 5640; I² = 99%; very low-quality evidence) or frequency (SMD -0.16, 95% CI -0.42 to 0.09; studies = 4; participants = 915; I² = 73%; very low-quality evidence). For this comparison, no trials reporting on the volume of alcohol use could be pooled in meta-analysis.

In general, the results remained consistent in separate subgroup analyses of universal, selective, and indicated interventions. No adverse effects were reported.

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